Care Manager
US-IL-Rock Island
careers
Req #: 158321
Type: Full Time Benefits
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Overview: Shift: Monday-Friday; 8:00 AM - 5:00 PM We are seeking a dedicated professional to join our care team and play a vital role in coordinating patient services. In this role, you will collaborate with interdisciplinary teams to ensure patients receive the right care at the right time. You'll be responsible for managing utilization by overseeing payment authorizations, clinical coordination, and discharge planning. Additionally, you'll support patients by monitoring care plans, addressing individual needs, and facilitating access to community resources to promote continuity of care. Responsibilities: * Performs utilization and case management reviews using established criteria to confirm medical necessity, appropriate level of care and efficient use of resources and payment approval. * Requests reviews with physician advisors, and/or Executive Health Resources (EHR), as appropriate, if admission or continued stay criteria are not met, assuring appropriate and timely level of care status. * Conducts payment authorizations and coordinated payment denials while meeting timeliness guidelines. * Ensures case coordination with client's health care providers. * Provides utilization management and case management to designated enrollees. Assuring that all enrollees receive clinically sound triage/referral and ongoing care management services for medical needs. Qualifications: Education: * Registered Nurse * CCM (Certified Case Manager) License(s)/Certification(s): * Compact Nursing License / or licensed behavioral health clinician. Required Illinois and Iowa licenses within first 90 days of hire. Experience: * 5+ years of nursing experience * Insurance experience on the company side is required. *Specific offers are determined by various factors, such as experience, skills, internal equity, and other business needs. The salary range listed does not include other forms of compensation which may include bonuses/incentive, differential pay, or other forms of compensation or benefits that may be applicable to this role. #RYCJessi #QC123
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